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Biomedical subjects

A Gallino

Publications and source records attributed to A Gallino.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Long-term results of surgical coronary vessel intervention in patients with reduced left ventricular function].

From 1975 to 1980, 112 patients with an ejection fraction below 45% underwent coronary artery bypass grafting (CABG) in the Cardiovascular Surgery Unit, University Hospital Zürich. The mean age was 35 years and the mean ejection fraction 32% (21-44%). The vast majority of patients had severe symptoms (angina pectoris or congestive heart failure). Elective surgery was performed in 62 patients (55%) and emergent or urgent in 50 (45%). All were operated on in mild hypothermia (26-30 degrees C). An average of 2.9 bypasses per patient were performed; in 57, internal mammary artery bypass was carried out for revascularization of the left anterior descending branch. - Early postoperative mortality (within 30 days of operation) was 3.6%; all deaths were of cardiac origin. Perioperative myocardial infarction occurred in 7.5% of all patients. Cumulative survival was 83% at 5 years and 68% at 9 years. Mean mortality rate/year was 3.8% with a maximum of 6.5% in the first year after operation. The incidence of angina pectoris and congestive heart failure was significantly lower after revascularization. Cumulative survival was significantly enhanced in patients with complete revascularization (91% at 5 years vs 71% for incomplete revascularization). Early postoperative mortality was especially high in urgent and emergent cases, and was higher after revascularization with internal mammary artery bypass than with venous graft. Postoperative ejection fraction was assessed in 20 patients (12 with 2- or 3-vessel disease and 8 with left main coronary artery stenosis). Ejection fraction was significantly increased only in the patient group with left main coronary artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Long-term performance of mitral valve bioprosthesis].

Long-term clinical performance of mitral tissue valves was analyzed in a consecutive series of 250 patients (131 men, 118 women; mean age 51 years) over a 13-year period. Mean follow-up was 71 months (range 1-141 months). The total cumulative follow-up period was 1466 years. The late mortality was 2.0% per patient-year, whereas thromboembolism occurred in 1.4% per patient-year, prosthetic valve endocarditis in 1.0% per patient-year, periprosthetic leaks in 0.3% per patient-year and structural valve deterioration in 3.0% per patient-year. The rate of reoperation was 3.4% per patient-year. Actuarial analysis showed the following results (1 year/5 years/10 years): Survival rate: 97 +/- 1%/89 +/- 2%/82 +/- 5%; free of embolisms: 98 +/- 1%/96 +/- 1%/86 +/- 5%; free of endocarditis: 99 +/- 1%/95 +/- 2%/90 +/- 3%; free of valve deterioration: 99 +/- 1%/96 +/- 1%/60 +/- 8%; no reoperation: 98 +/- 1%/94 +/- 2%/57 +/- 8%; free of late complications: 92 +/- 2%/77 +/- 4%/41 +/- 10%. On the basis of our statistical evaluation the probabilities are that, 11 years after implantation of a mitral bioprosthesis: (a) only 35% of patients are free of late complications (including thromboembolisms, prosthetic valve endocarditis, structural valve deterioration and death); (b) and only 50% of patients have not needed reoperation.

Actuarial Analysis↗
PubMed1990

Superior hemodynamics in left heart bypass without systemic heparinization.

Open-chest left heart bypass was performed in 10 canine experiments (30 +/- 9 kg) by a servo controlled roller pump for 6 h at a pump flow of 50 ml/min per kg bodyweight. The surfaces of the tubing sets were either standard (with systemic heparinization) or with end-point attached heparin (no systemic heparin). Besides continuous monitoring of hemodynamics, a standard battery of blood samples was taken before bypass, after 10 min and every hour thereafter. There is no evidence of increased fibrin production in the group with end-point attached heparin surfaces perfused without systemic heparinization. Superior hemodynamics in left heart bypass performed without systemic heparinization appear to be due to improved hemostasis, reduced blood loss and therefore reduced transfusion requirements. Left heart bypass with heparin-coated equipment has been successfully used for resection of a thoracoabdominal aneurysm in six patients.

Animals↗
PubMed1990

Reduced blood loss and transfusion requirements with low systemic heparinization: preliminary clinical results in coronary artery revascularization.

In coronary artery revascularization, low systemic heparinization was compared to full systemic heparinization during perfusion with heparin surface-coated cardiopulmonary bypass equipment. Twelve patients were randomly assigned to two groups and perfused with low [activated clotting time (ACT) greater than 180 s] or full (ACT greater than 480 s) systemic heparinization. A standard battery of blood samples was taken before the procedure, after heparinization, and at regular intervals during and after cardiopulmonary bypass. No differences were seen between the two groups in regard to age, body surface area, preoperative hematocrit, duration of bypass, bypass hypothermia, cross-clamp time, and number of bypasses per patient. However, there were more internal thoracic artery (ITA) grafts in the group with low systemic heparinization (1.5 +/- 0.8 ITA grafts per patient versus 0.8 +/- 0.4 ITA grafts per patient with full heparinization; p less than 0.05). The oxygenator gradient at the end of perfusion (before weaning) was 107 +/- 40 mmHg for low versus 110 +/- 10 mmHg for full heparinization (difference not significant). The total amount of heparin used was 7200 +/- 1030 IU for low versus 51400 +/- 9700 IU for full (p less than 0.05). Postoperative hematocrit was 35.0 +/- 2.0% for low versus 24.7 +/- 2.7% for full (p less than 0.05). Total chest tube drainage was 428 +/- 153 ml/m2 for low versus 935 +/- 414 ml/m2 for full (p less than 0.05). Homologous transfusions of blood products were necessary in 3/6 patients for low versus 6/6 patients for full (p less than 0.10).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Coagulation↗
PubMed1990

Performance characteristics of centrifugal pumps with heparin surface coating.

Heparin surface coating is one approach to improve the biocompatibility of existing blood pumps used for mechanical circulatory support. Experimental evaluation of centrifugal pumps with heparin surface coating was performed during open chest left heart bypass (3.7 L/min over 6 hours) in two series of bovine experiments. Eight calves (74 +/- 4 kg) were perfused either by heparin surface coated equipment without systemic heparinization or uncoated equipment with systemic heparinization (300 I. U,/kg bodyweight; ACT greater than 400 s). A standard battery of analyses was performed before and at regular intervals after onset of perfusion. At the end of perfusion all pump-heads were gently rinsed. There were no macroscopic clots for both groups whereas macroscopic clots were observed in uncoated tubings introduced for control in the group perfused without systemic heparinization. The hemodynamics were significantly better in the group perfused without systemic heparinization and maintained functional coagulation system. Clinical application of heparin surface coated equipment during resection of thoraco-abdominal aortic aneurysms is showing promising results in 12 patients.

Animals↗
PubMed1990

[Cytomegalovirus (CMV) infection: a frequent and life-threatening complication in heart transplant patients].

We investigated the clinical relevance of cytomegalovirus infection in our heart transplant recipients (n = 48). There was a high incidence of CMV-infection in patients where IgG positive donor versus IgG negative recipient was present. A total of 5/8 patients (= 62.5%) showed severe clinical CMV-infection with pneumonitis, colitis or tonsillitis besides general malaise, requiring long hospital treatment (2 to 24 weeks). CMV-infection is a frequent and threatening complication in patients after heart transplant (HTPL). We discuss the various managements in diagnosis, prophylaxis and treatment.

Antibodies, Viral↗
PubMed1990

[Surgical and perioperative problems of heart transplantation].

Orthotopic heart transplantation is an established treatment for terminal cardiac diseases. Close cooperation and coordination with other clinics and laboratories is mandatory to transplant a good organ with minimal ischemic time. Accurate donor evaluation and treatment is essential for fast recovery after operation. Our series is 79 orthotopic heart transplantations form 9/85 to 10/89 in 78 patients. Average ischemic time is 38 minutes in organ procurement from table to table and rises distinctly in distal heart procurement (n = 33), but is usually under 120 minutes at organ procurement from any place in Switzerland. The transplantation is performed in the technique from Lower and Shumway. Immunosuppression with triple therapy (Cyclosporin A, Azathioprim, Prednisone) and initial cytolytic therapy is well tolerated. Consequent diagnosis and treatment for rejection and infections lead to good short and medium term survival. Prophylactic treatment is indicated in high risk constellation for cytomegalovirus and toxoplasmosis infection. Early mortality (less than 30 days) was two out of seven and caused by bacterial infections. Actuarial survival is 91% at one and two years and 85% at three years with good quality of life and NYHA class I.

Heart Diseases↗
PubMed1990

[Graft rejection reaction and immunosuppression following heart transplantation].

Acute rejection is the most important factor influencing mortality after heart transplant. Acute rejection occurs at least once in over 95% of the patients in the early phase after heart transplant. In the vast majority of episodes of acute rejection clinical symptoms are absent. The regular performance of endomyocardial biopsy after heart transplant allows histological diagnosis of rejection episodes as well as follow-up control of rejection treatment. This overview points to the major problems regarding acute rejection and immunosuppressive regimen in heart transplant recipients.

Graft Rejection↗
PubMed1990

[Toxoplasmosis in the heart transplant patient].

Toxoplasmosis is a well-known problem under immunosuppressive conditions in cardiac transplant patients. In our series 12% of the patients (8 of 65) had clinical and/or serological signs of active toxoplasmosis. Due to its serious prognosis once the clinical process has started we favor a generous diagnostic interpretation of the serological results and a broad indication to drug therapy.

Animals↗
PubMed1990

[Long-term follow-up after heart transplantation].

Actuarial survival rate two years after heart transplant in our patients is 90%. The most patients report excellent quality of life (NYHA I) and present definitely improved work load capacity as well as normal cardiac hemodynamic assessment two years after transplant. The major problems in the long follow-up of heart transplant recipients are accelerated coronary disease (graft atherosclerosis), arterial hypertension and renal function impairement.

Cause of Death↗
PubMed1989

[Results of the initial 50 heart transplantations in Zurich].

During the first 40 months of the new Heart Transplantation Program (September 1985 until December 1988) a total of a 160 patients were evaluated for transplantation at the University Hospital in Zurich. 50 patients eventually came to heart transplantation, while one patient underwent a heart-lung transplant. In the same period 9 patients accepted for transplantation died on the waiting list before transplantation. All 50 hearts were transplanted orthotopically. Follow-up treatment, immunosuppression and diagnostics for rejection are described. There was no operative mortality in this group. Two patients died early and three died late. For the first consecutive 50 heart transplant patients, showing a total of 732 patient months, actuarial survival was calculated at 90.1% at one and two years, and at 79.5% at three years. "Enlarged Heart Transplantation Program" describes some of the secondary activities spurred by the new Heart Transplantation Program.

Actuarial Analysis↗
PubMed1989

Postinfarction ventricular septal defect--surgical strategies and results.

Twenty consecutive patients with postinfarction ventricular septal defect (VSD) were subjected to surgery: there were 8 females and 12 males with a mean age of 67 +/- 9 years. Nine acute patients developed cardiogenic shock, and intra-aortic balloon pump was started before surgery (with IABP). Eight acute patients showed preoperatively relatively stable hemodynamics, and surgery was feasible without previous use of the intra-aortic balloon pump (without IABP). The interval between myocardial infarction and surgery was 13 days for 17 acute cases. In the group with IABP the interval was 8 +/- 5 days versus 19 +/- 11 days in the group without IABP (p less than 0.025). VSD patch closure was performed in 20/20, resection of infarct in 10/20, transventricular approach without resection of infarct in 3/20, patch enlargement of the left ventricle in 2/20, plicature of an aneurysm in 3/20, aorto-coronary bypass in 10/20 (number of bypasses: 2.1 +/- 1.3) and mitral annuloplasty in 1/20. The perioperative 30 days mortality was 5/20 (25%) for the whole series. In the group with IABP mortality was 4/9 (44%) versus 1/8 (13%) in the group of acute patients without IABP (p less than 0.05). Mean follow-up for the 15 surviving patients was 1.7 +/- 1.0 years. Two patients died during the first year, one of them due to carcinoma. After 1 year, mean NYHA functional class was assessed 1.5 +/- 0.6. One patient showed a residual VSD which was closed surgically. Immediate closure of a postinfarction ventricular septal defect is the therapy of choice of this complication of acute myocardial infarct with a natural history showing an extremely high mortality.

Aged↗
PubMed1989

[Endomyocardial biopsy following heart transplantation: results and complications].

Heart transplantation (HTPL) has worldwide become a well established therapy of terminal heart failure. Besides non-invasive parameters the endomyocardial biopsy (EMB) is proved to be the goldstandard method for early detection of graft rejection. At the University Hospital of Zurich 31 HTPL have been performed between September 1985 and December 1987. 100 out of 460 EMB's showed moderate or severe rejection and needed additional immunosuppressive treatment. 1.5% of all EMB's caused further treatment due to local or systemic complications.

Biopsy↗